Magnetic resonance imaging in the diagnosis of tuberculous arthritis

A complex of clinical radiation and MRI studies of the joint was conducted in 45 patients with tuberculous arthritis. Two major forms of tuberculous lesion of the joint were identified: primary osseous tuberculous arthritis (79.6%) and tuberculous allergic synovitis (20.4%). In patients with tuberculous allergic synovitis, MRI revealed a nonspecific exudative proliferative response of the synovial membrane and edema of the bone marrow and periarticular tissues. In primary osseous tuberculous arthritis, MRI showed tuberculous inflammation foci in the epiphysis of the bone; proliferative changes in the synovial membrane, destruction of cartilaginous, fibrous, and osseous structures, as well as periarticular abscesses.     

Tuberculous arthritis of the shoulder: Delayed diagnosis aided by arthrography

Clinical Rheumatology - Tuberculous arthritis of the shoulder was not diagnosed in an 80-year-old man with Addison's disease until the appearance of a draining abscess in his arm. Initially...     

A review of peripheral tuberculous arthritis

There is a clear difference between TB infection and TB. Transition from the former to the latter involves host factors and perhaps environmental elements. Currently, more individuals with immunosuppressive situations caused by aging, debilitating diseases, immunosuppressive therapies, and HIV-III infection are predisposed to secondary forms of TB. Different patterns of clinical presentation, at variance with those previously described, could result from these changes in the host. PTBA is a good example. In the present review of 52 patients, we found that patient age is rising, as has been reported in other western countries. We also found that oligoarthritis and involvement of non-weight-bearing joints is becoming more common. From the diagnostic point of view, histological studies and cultures of synovial tissue remain the most reliable tests. Awareness of these factors, recognition of changing patterns, proper use of diagnostic procedures, and early treatment should improve the outcome of patients.     

Extraspinal tuberculous arthritis in HIV era

A worldwide reemergence of tuberculosis is appreciable. Extrapulmonary tuberculosis has been observed to increase disproportionately from past incidence. One of the main attributing factors is the human immunodeficiency virus (HIV) infection. The objective of this study was to study clinical features, laboratory findings, and association with HIV infection in patients with peripheral tuberculous arthritis. The retrospective study was performed by reviewing the medical records of 27 patients with extraspinal tuberculous arthritis treated from January 1994 to December 2002. The diagnosis was made either by compatible clinical presentation and positive culture for Mycobacterium tuberculosis or histological finding of caseating granuloma in biopsy tissue or both. The average age of the patients’ population was 49.3 years (range 27–74 years), made up of a 52% or 14 patients of male subjects. The mean duration of disease before seeking medical treatment was 10.2+11 weeks and from onset to diagnosis was 25 weeks. The most frequently affected joints were knees (36.6%) followed by wrists, ankles, shoulders, hips, sacroiliacs, and elbows, respectively. Monoarthritis was the main feature of this group, except for two patients who had two and three joints involvement, respectively. Dactylitis (tenosynovitis) was also found in two out of the 27 patients. Six patients (24%) had active pulmonary infiltration on chest X-ray. Of 11 patients with synovial polymerase chain reaction (PCR) testing for tuberculosis, seven patients had positive result. Only one patient with extraspinal tuberculous arthritis tested positive for HIV. Therefore, extraspinal tuberculous arthritis is observed to be usually present with chronic monoarthritis. The diagnosis is delayed in most occasions. PCR from synovial fluid may facilitate rapid diagnosis of tuberculous arthritis. Human immunodeficiency virus may not be a main contributing factor for extraspinal tuberculous arthritis.     

Clinical and diagnostic features of tuberculous arthritis

Clinical and diagnostic features of twenty-five patients with tuberculous arthritis were reviewed. Local or systemic factors which may have predisposed to articular involvement were narcotics addiction, direct joint trauma, intra-articular steroid injections and systemic illness. Of the twenty-five patients studied, sixteen were under forty years of age and fifteen were black. All patients had monoarticular arthritis of insidious onset, all had a positive skin test with intermediate strength purified protein derivative, and all but three had joint abnormalities on roentgenograms. Weight bearing joints were more frequently affected. Cultures of synovial fluid and tissue were positive in seventeen of eighteen patients. Histologic examinations demonstrated granuloma (eleven caseating and nine noncaseating) in nineteen of twenty patients. Thus, culture and histologic examination are of equal importance in the definitive diagnosis of tuberculous arthritis.     

结核性腹膜炎的实验室诊断

目的评价聚合酶链反应（ＰＣＲ）结合Ｓｏｕｔｈｅｒｎ杂交技术及酶联免疫吸附试验（ＥＬＩＳＡ）对结核性腹膜炎的诊断价值。方法用ＰＣＲ结合地高辛标记核酸探针Ｓｏｕｔｈｅｒｎ杂交技术检测４２例结核性腹水中结核分支杆菌ＤＮＡ，并与常规细菌学检测及ＥＬＩＳＡ对比。引物来自结核分支杆菌特异重复插入序列ＩＳ６１１０。特异性通过杂交及限制性内切酶ＳａｌⅠ酶切证实。同时比较了Ｓｏｕｔｈｅｒｎ杂交检测与凝胶电泳检测的敏感性。结果ＰＣＲ的敏感性为６９％，ＥＬＩＳＡ为７１％，培养为９％，涂片镜检均为阴性。并发现杂交较凝胶电泳检测更敏感。结论ＰＣＲ和ＥＬＩＳＡ法对结核性腹膜炎有较高的诊断价值，但前者更具有特异性。将Ｓｏｕｔｈｅｒｎ杂交技术与ＰＣＲ技术结合，可进一步提高检测的敏感性和特异性。     

Meningitis associated with tuberculous arthritis of the knee

This case report describes two uncommon manifestations of tuberculosis, meningitis and arthritis, occurring in a patient without pulmonary disease. Difficulties in diagnosis and results of treatment are discussed.     

Isolated tuberculous arthritis of the dorsal facet joint

IntroductionSeptic arthritis of the facet joint is a severe infection. The lumbar spine is frequently involved; the dorsal one is rarely affected.Case reportWe present a case of a patient with a history of right cervicobrachial neuralgia with anorexia and asthenia without fever. Performed investigations had concluded to tuberculous arthritis of the dorsal facet joint. The tuberculous etiology is an originality of our observation since it has been reported in only one case. In the absence of histological and bacteriological proof, the diagnosis was established according to clinical, epidemiological and biological data. Treatment was based on antitubercular antibiotics.ConclusionThe tuberculous origin of septic facet joint should be considered in front of trolling and unexplained back pain, especially in endemic countries.     

结核性脑膜炎实验室和影像学诊断研究进展

结核性脑膜炎的预后与早期诊断和治疗密切相关,提高结核性脑膜炎早期诊断率是改善预后的关键。本文从实验室检测和影像学检查两方面综述了结核性脑膜炎诊断研究进展。